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When the alveoli are filled with excess fluid, it leaves the lung’s blood vessels instead of air. This interferes with gas exchange and can cause respiratory failure.
Pulmonary edema can be acute (sudden onset) or chronic (occurs more slowly over time). It is classified as a medical emergency that needs immediate attention if it is sensitive. The term edema is from the Greek οἴδημα (oídēma, “swelling”).
Pulmonary edema is a condition that involves the accumulation of fluid in the lungs, and sudden-onset (acute) pulmonary edema is a medical emergency. Sometimes, a chest x-ray can help diagnose pulmonary edema.
Causes of pulmonary edema
The most common cause of pulmonary edema is congestive heart failure, in which the heart can not keep up with the demands of the body.
During normal breathing, the tiny alveoli of the lungs fill with air. The oxygen is absorbed, and the carbon dioxide is expelled. Pulmonary edema occurs when the alveoli flood.
When the alveoli are flooded, two problems occur:
- The bloodstream can not get enough oxygen.
- The body can not eliminate carbon dioxide appropriately.
Common causes include:
- Pneumonia.
- Sepsis (infection of the blood).
- Exposure to some chemicals.
- Organic insufficiency causes fluid accumulation: congestive heart failure, renal failure, or liver cirrhosis.
- Feeling of drowning.
- Inflammation.
- Trauma.
- Reaction to certain medications.
- Drug overdose.
In addition to direct injury to the lungs, as in acute respiratory distress syndrome, other causes include:
- Brain injuries include brain hemorrhage, stroke, head injury, brain surgery, tumor, or seizure.
- High altitude
- Blood transfusion.
Signs and symptoms of pulmonary edema
The development of pulmonary edema may be associated with symptoms and signs of “fluid overload.”
This is a non-specific term to describe the manifestations of right ventricular failure in the rest of the body.
It includes peripheral edema (swelling of the legs, in general, of the “sting” variety, in which the skin takes time to return to normal) when it is pressed.
Elevated jugular venous pressure and hepatomegaly, where the liver is enlarged and may be sensitive or even throbbing.
Other common symptoms may include easy tiredness, shortness of breath of development faster than usual with habitual activity (dyspnea on exercise), rapid breathing (tachypnea), dizziness, or weakness.
Acute pulmonary edema causes significant breathing difficulties and may appear without warning. This is an emergency and requires immediate medical attention. Without the proper treatment and support, it can be fatal.
Along with breathing difficulties, other signs and symptoms of acute pulmonary edema may include:
- Cough, often with pink foamy sputum.
- Excessive sweating
- Anxiety and restlessness
- Feelings of suffocation.
- Pale skin.
- Wheezing
- Rapid or irregular heart rhythm (palpitations).
- Chest pain.
If the pulmonary edema is chronic, the symptoms are usually less severe until the body’s system can no longer compensate. Typical symptoms include:
- Difficulty breathing when lying down ( orthopnea ).
- Swelling (edema) of feet or legs.
- Rapid weight gain due to the accumulation of excess fluid.
- Dyspnoea paroxysmal nocturnal, sudden episodes of severe breathlessness at night.
- Fatigue.
- Increased difficulty in breathing with physical activity.
Pulmonary edema or pleural effusion
Pulmonary edema occurs when fluid builds up inside the lungs and alveoli, making breathing difficult. The pleural effusion also involves fluid in the lung and is sometimes called ” water in the lungs .”
However, in pleural effusion, water fluid accumulates in the layers of the pleura that are outside the lungs. It can be a consequence of heart failure, cirrhosis, or pulmonary embolism. It can also happen after heart surgery.
Pulmonary edema or pneumonia
Pulmonary edema may overlap with pneumonia, but it is a different condition. Pneumonia is an infection that often occurs due to respiratory disease, such as the flu.
It can be challenging to distinguish between the two. If the person or a family member can provide a detailed medical history, it will be easier for a doctor to make the correct diagnosis and provide the appropriate treatment.
Types
Classically it is cardiogenic (left ventricle), but fluid can also accumulate due to damage to the lung. This damage can be a direct injury or injury mediated by high pressures within the pulmonary circulation.
When it is caused directly or indirectly by increased left ventricular pressure, pulmonary edema may form when the average pulmonary pressure rises from regular from 15 mmHg to more than 25 mmHg.
In general terms, the causes of pulmonary edema can be divided into cardiogenic and non-cardiogenic. By cardiogenic convention, it refers to the grounds of the left ventricle.
Cardiogenic
Pulmonary edema due to an immediate problem with the heart is called cardiogenic.
Congestive heart failure is a common cause of cardiogenic pulmonary edema; In this condition, the left ventricle can not pump enough blood to meet the body’s needs.
This causes a buildup of pressure in other parts of the circulatory system, forcing fluids to enter the lungs’ alveoli and other body parts.
Other problems related to the heart that can lead to pulmonary edema include:
Fluid overload: This may result from kidney failure or intravenous fluid therapy.
Hypertensive emergency: a severe increase in blood pressure that puts excessive pressure on the heart.
Pericardial effusion with tamponade: fluid accumulation around the sac covering the heart. This can decrease the heart’s ability to pump.
Severe arrhythmias: this may be tachycardia (rapid heartbeat) or bradycardia (slow heartbeat). Either one can cause poor cardiac function.
A severe heart attack can damage the heart muscle and make it difficult to pump.
Abnormal heart valve: it can affect the flow of blood that leaves the heart.
The causes of pulmonary edema that are not due to poor cardiac function are called non-cardiogenic; They are usually caused by acute respiratory distress syndrome.
This is a severe inflammation of the lungs that leads to pulmonary edema and significant breathing difficulties.
Others
Lung injury can also cause pulmonary edema due to damage to the vasculature and lung parenchyma. Acute respiratory failure syndrome (ALI-ARDS) encompasses many of these causes but may include:
Inhalation of hot or toxic gases. Aspiration, for example, gastric fluid. Reperfusion injury that is posted pulmonary thromboendarterectomy or lung transplantation. Pulmonary contusion is high energy trauma (for example, vehicle accidents).
After a high-volume thoracentesis, resolution of pneumothorax, post-decortication, elimination of endobronchial obstruction, a form of negative pressure pulmonary edema.
Circulatory overload associated with transfusion (TACO) occurs when multiple transfusions of blood or blood products (plasma, platelets, etc.) are transfused over a short period.
Transfusion-associated acute lung injury (TRALI) is a transfusion injury of blood products that occurs when the donor’s plasma contains antibodies to the donor, such as anti-HLA or anti-neutrophil antibodies.
Infection or severe inflammation can be local or systemic. This is the classic form of acute lung injury.
Arteriovenous malformation: Hantavirus pulmonary syndrome.
Sudden pulmonary edema
Sudden pulmonary edema (FPE) is rapid-onset pulmonary edema.
It is precipitated by acute myocardial infarction or mitral regurgitation in most cases. Still, it can be caused by aortic regurgitation, heart failure, or almost any cause of elevated left ventricular filling pressure.
The treatment of sudden pulmonary edema should be directed to the underlying cause, but the pillars ensure oxygenation, diuresis, and decreased pulmonary circulation pressures.
It is believed that the recurrence of sudden pulmonary edema is associated with hypertension and may signify stenosis of the renal artery. The prevention of recurrence is based on managing hypertension, coronary artery disease, renovascular hypertension, and heart failure.
Diagnosis
The patient will first undergo a physical examination. The doctor will use a stethoscope to listen to the lungs for crackles and rapid breathing and the heart for abnormal rhythms.
Low oxygen saturation and alteration of arterial gas readings support the proposed diagnosis by suggesting a pulmonary shunt.
The chest radiograph will show fluid in the alveolar walls, Kerley B lines, increased vascular shading in a classic perilesional pattern of batwing, deviation of the upper lobe (increased blood flow to the upper lung), and possibly pleural effusions.
In contrast, patchy alveolar infiltrates more typically associated with non-cardiogenic edema.
Lung ultrasound, used by a health care provider at the point of care, is also a valuable tool for diagnosing pulmonary edema.
It is accurate, but it can quantify the degree of pulmonary water, track changes over time, and differentiate between cardiogenic and non-cardiogenic edema. Low levels of BNP (<100 pg/ml) suggest an unlikely cardiac cause.
Blood tests will be done to determine oxygen levels in the blood; The doctor will often order other blood tests, which include:
- Electrolyte levels.
- The function of the kidney.
- Liver function
- Blood counts and blood markers of heart failure.
An ultrasound of the heart, an echocardiogram, and an electrocardiogram (EKG) can help determine the condition of the heart.
Prevention of pulmonary edema
Effective control of congestive symptoms prevents pulmonary edema in those with underlying heart disease.
Patients at increased risk of developing pulmonary edema should follow their doctor’s advice to keep their condition under control.
If the problem is congestive heart failure, following a healthy and balanced diet and maintaining a healthy body weight can help reduce the risk of future episodes of pulmonary edema.
Regular exercise also improves the health of the heart as it does:
Reduce the consumption of salt: excess salt can lead to water retention. This increases the work that the heart has to do.
Decreased cholesterol levels: high cholesterol can cause fatty deposits in the arteries, increasing the risk of heart attack and stroke and, therefore, pulmonary edema.
Stop smoking: tobacco increases the risk of several diseases, including heart disease, lung diseases, and circulatory problems.
Altitudinally induced pulmonary edema can be minimized by a gradual ascent, taking medications before traveling, and avoiding excessive effort while moving at higher altitudes.
Treatment for pulmonary edema
The treatment of pulmonary edema generally focuses on improving respiratory function and dealing with the source of the problem. It usually includes providing oxygen and additional medications to treat the underlying conditions.
Pulmonary edema can be acute or chronic. To raise oxygen levels in the patient’s blood, oxygen is administered through a mask or tips and small plastic tubes in the nose.
A breathing tube can be placed in the windpipe if a respirator is necessary.
Suppose the tests show that the pulmonary edema is due to a problem in the circulatory system. In that case, the patient will be treated with intravenous medications to help eliminate the volume of fluid and control blood pressure.
Cardiogenic pulmonary edema
Acute cardiogenic pulmonary edema often responds quickly to medical treatment. Positioning yourself upright can relieve symptoms.
To reduce respiratory distress, loop diuretics such as furosemide or bumetanide are administered, often with morphine or diamorphine.
Diuretics and morphine can have vasodilating effects, but specific vasodilators (particularly intravenous glyceryl trinitrate or ISDN) can be used if blood pressure is adequate.
